Orthopedic Nurse Certification (ONC) Test Review

The Orthopedic Nurse Certification indicates specialization in treating patients who have undergone orthopedic surgery or are under orthopedic care. Orthopedic Nurses may provide direct care, work in an education or administrative capacity, or may even assist in some of the orthopedic procedures.

In order to take the Orthopedic Nurse Certification exam, the applicant must be a licensed Registered Nurse, but a Bachelor's Degree is not required. The RN must have been employed for at least 2 years in order to apply to take the exam. In addition, at least 1,000 hours of providing patient care to orthopedic patients should have been completed within the last 3 years.

The exam is offered at testing centers throughout the United States on two specific testing dates per year, usually Spring and Fall. The fee to take the Orthopedic Nurse Certification exam is $220 for members of the National Association of Orthopaedic Nurses (NAON) and $320 for non-members.

The exam tests the RN's knowledge of all aspects of Orthopedic Nursing. Over one-quarter of the exam addresses issues degenerative diseases. Trauma and sports injuries make up the next two largest sections of the exam, and the remainder of the exam focuses on other orthopedic disease processes.

The Orthopedic Nurse Certification is valid for 5 years. At the end of that time period, the RN must have completed at least 100 hours of continuing education credits with at least 70 of those hours in Orthopedic Nursing. In addition, at least 1,000 hours of employment in which the RN provides patient care to orthopedic patients is necessary. The fee for recertification is $200 for NAON members and $300 for non-members.

Orthopaedic Nurse Certification (ONC) Practice Questions

1. Which of the following conditions is a CONTRAINDICATION for use of the supine sling?

Osteoporosis with degenerative disk disease

Rheumatoid arthritis

Severe respiratory compromise

Stroke with hemiplegia

2. Concurrent administration of which of the following increases gastrointestinal toxicity
and bleeding related to long-term NSAID therapy?

Proton pump inhibitor

Antacid

Acetaminophen

Steroid

3. Which of the following is the most common treatment for carpal tunnel syndrome?

Corticosteroid injections

Stretching exercises

Splinting

Surgical repair

4. Which of the following is the correct position for the patient during application of a
figure-8 clavicle strap for a right clavicular fracture?

Sitting in upright attention position

Leaning forward

Supine

Left-lying

5. A 30-year-old patient in good physical condition with a non-weight-bearing cast is
preparing for discharge. Which method of ambulation is usually indicated?

Ambulation with 4-wheeled Roll-A-Bout walker

Ambulation with pickup or 2-wheeled walker

Crutch walking, 3-point gait

Crutch walking, 4-point gait

Orthopaedic Nurse Certification (ONC) Answer Key

1. Answer: C

The supine sling is contraindicated for patients with severe respiratory compromise
because it precludes elevation of the head and may increase respiratory distress. The supine
sling can be used with almost any other patient, especially those who must remain flat or
cannot tolerate more upright positions. The supine sling is used for lateral transfers,
bathing, repositioning, changing linen, rescuing after a fall, and transferring of a deceased
patient. Supine slings may be padded or unpadded and may be made of mesh to facilitate
bathing.

2. Answer: D

Steroids given concurrently with NSAIDs increase risk of GI toxicity and bleeding, so
this is a particular problem for those with rheumatoid arthritis. NSAIDs should be
administered with food. Concurrent administration of a proton pump inhibitor (such as
omeprazole) or an antacid may reduce risk, although antacids may mask symptoms to some
degree. Acetaminophen does not usually cause GI upset or bleeding, and the combination of
an NSAID and acetaminophen may be more effective for pain control than the NSAID alone.

3. Answer: C

The most common treatment for carpal tunnel syndrome is splinting to maintain the
wrist in a neutral position and prevent further compression of the nerve. Carpel tunnel
syndrome occurs when the median nerve is compressed within the carpel tunnel, formed
from ligaments, tendons, and bones, between the forearm and the hand. Initial symptoms
include numbness, tingling, or burning in the hand, especially the palm, thumb, and index
and middle fingers, with eventual weakening and inability to grip. Compression increases
when the wrist is flexed, so the symptoms may worsen during sleep. Corticosteroid
injections are usually now avoided because they may result in nerve damage or scarring.
Gentle stretching may reduce pain.

4. Answer: A

The patient should sit upright in attention position for application of the figure-8
clavicle strap, as this keeps bones in proper alignment; however, the patient may require
pain medication prior to assuming this position and may need to assume the position
slowly. Prior to application of the strap, the arm and hand on the fracture side should be
assessed for neurological or vascular impairment, noting color, temperature, sensation,
numbness or tingling, motor function, and strength of pulses.

5. Answer: C

A patient in good physical condition with a non-weight-bearing cast is usually
instructed in crutch walking with a 3-point gait. The 4-point gait is used with a partialweight-
bearing cast. Elderly patients and patients with poor balance or an inability to use
crutches may use walkers. Two-wheeled or pickup walkers are easy to control, but
ambulation is slower, as the person must step toward the walker, advance the walker, and
then step again. The Roll-A-Bout walker may be used for those who are unable to manage
crutches, but it requires weight bearing on the knee.